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PubMed · 9282421

Managing self-harm: the legal issues.

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Abstract

Each year about 100,000 people present to UK hospitals with deliberate self-harm, the most common form of which is poisoning with medicines or other pharmacologically active substances. As may as 95% of self-poisonings are intentional drug overdoses but only around 40% of patients who poison themselves express a wish to die. In many instances, the final outcome is determined by the speed with which treatment is started. Here we concentrate on the legal issues facing doctors when patient declines treatment.

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Drug OverdoseHumansInformed ConsentMental CompetencySelf-Injurious BehaviorTreatment RefusalJournal ArticleReview

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BibTeXRIS

1997. Managing self-harm: the legal issues.. https://doi.org/10.1136/dtb.1997.35641

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PubMed2007

London audit of drug-related overdose deaths: characteristics and typology, and implications for prevention and monitoring.

OBJECTIVES: To describe the circumstances and draft a typology of drug-related overdose deaths. SETTING: London, 2003. METHODS: An audit of 148 drug overdose deaths (involving heroin, methadone, dihydrocodeine, cocaine, amphetamine or MDMA) investigated by coroners during 2003. Information extracted on toxicology, pathology and circumstances were used to identify drug(s) implicated in the death. RESULTS: Poly- or multiple drug use was detected in the majority of deaths with at least 69 different combinations, including 66% for heroin and 42% for cocaine. Six categories of death were identified involving an opiate (100, 68%); cocaine (14, 9%); other controlled drug (five, 3%); mixed drug overdose (18, 12%); other prescribed drug (five, 3%); and other causes (seven, 5%). A witness was present and the death was not instantaneous in 92 (61%) cases, although evidence in the coronial file suggested that in the majority of cases the overdose went unnoticed until too late to intervene. In all, 15 (one in 10) of the deceased were released from prison within 3 months of death; and 37 (one in four) were reported as in receipt of a methadone prescription. CONCLUSIONS: Perhaps for the first time in the United Kingdom cocaine was detected in more drug overdose deaths than methadone. However, reducing heroin use is central to the prevention of drug-related deaths. We recommend that overdose prevention encompasses strategies to encourage a 'mutual duty of care' among problem drug users, and in the United Kingdom further investigation of the relationship of methadone treatment failures on overall trends in drug-related deaths is merited.

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